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 Success Through Collaboration

Making Phased Military Construction Contracts Work

Scheduled for completion in December 2015, the Wilford Hall Ambulatory Surgical Center at Joint Base San Antonio-Lackland will be able to accommodate more than 2,500 patient visits per day.

 

By Ryan Aalsma, M.SAME, Jack Sullivan, P.E., PMP, M.SAME, and Jeffrey Allen

   


The Wilford Hall Ambulatory Surgical Center in San Antonio will serve more than 55,000 patients annually and be able to accommodate over 2,500 patient visits per day.

The Wilford Hall Ambulatory Surgical Center in San Antonio will serve more than 55,000 patients annually and be able to accommodate over 2,500 patient visits per day. PHOTO BY AERO PHOTO


 

In December 2015, construction on the largest ambulatory care center the Department of Defense has ever built is slated for completion.

As part of the 2005 Base Realignment and Closure program, a number of military medical training and health care facilities were realigned in the San Antonio area. This included transferring inpatient medical services for all San Antonio military bases to Brooke Army Medical Center, which was later renamed the San Antonio Military Medical Center and located at Joint Base San Antonio-Fort Sam Houston.

Joint Base San Antonio-Lackland’s existing treatment facility, Wilford Hall Medical Center, was not set up to be an outpatient facility and was in need of modernization. A decision was made to build a world-class ambulatory care center to replace it. This required the U.S. Air Force to develop, design and construct a state-of-the-art LEED Silver replacement hospital.

When complete, the new Wilford Hall Ambulatory Surgical Center will serve more than 55,000 patients annually and be able to accommodate over 2,500 patient visits per day. A team comprised of Skanska, HDR and the Fort Worth District of the U.S. Army Corps of Engineers (USACE), is finalizing work on the first three phases for the $457 million, 681,581-ft² “super clinic.”

 

NO SMALL TASK

Many challenges have been encountered, and overcome, during this massive medical design and construction project—most notably the multi-phase nature of the work.

During the planning phase, the Air Force intended for a single project, to include over 645,000-ft² of clinics, a central energy plant, parking garage, utility infrastructure and improvements to the existing site. However, concerns over funding led the project to be split into four phases. As architect-of-record, HDR developed an overall 20 percent concept design for the entire program and upon approval of the major stakeholders (USACE, the Air Force and the Defense Health Agency), each phase of the program was carried to 100 percent design. HDR then developed design-build bridging documents for phase one and delivered 100 percent construction documents for phases two and three.

Each phase has had a separate procurement process along with multiple delivery methods. The phased process involved several contractors, more than a dozen stakeholders, and the need to design and construct each phase as a “complete and usable facility.” In addition, the Air Force required full access to neighboring Wilford Hall until its demolition in phase four.

Skanska was awarded phase two in 2011 and phase three in 2012 through lump sum, design-bid-build solicitations. The two phases accounted for 600,000-ft² of the facility and improvements to the project site. At the time, phase one was still under construction by the first general contractor, J.E. Dunn. The Skanska team needed to share the project site, which carried additional logistical challenges. For example, the excavation required for the phase two foundations was directly adjacent to the north side of the phase one building.
Furthermore, in phase one, a utility tunnel was installed that ran directly through the phase two excavation site. This created complications regarding safety, ingress and egress, phasing of work and protection of completed work.

While many of the circumstances on the Wilford Hall Ambulatory Surgical Center are unique, there are key takeaways any design and construction team should consider when undertaking a military construction project.

While many of the circumstances on the Wilford Hall Ambulatory Surgical Center are unique, there are key takeaways any design and construction team should consider when undertaking a military construction project. IMAGE COURTESY HDR INC.


 

CULTURE FOR SOLUTIONS

The team set up weekly coordination meetings to ensure the general contractors, HDR, and USACE were in constant contact. This created a culture for solutions. These meetings brought together the mid-level decision-makers to hash out the details of the project, to discuss how to overcome emerging challenges, coordinate issues, and share status reports. While these weekly meetings were extremely helpful, the complex nature of the activities on site frequently required daily meetings as well. The topic of safety was prioritized in every meeting by all participants. To date, the project teams have delivered a strong safety record, with no major time-loss incidents.

In addition, quarterly principal’s meetings brought together key representatives from Skanska, HDR and all the agencies involved to focus on larger, big-picture issues. As the project nears its end, this group now meets monthly to ensure a smooth opening and transition.

 


Many challenges have been encountered, and overcome, during this massive medical design and construction project—most notably the multi-phase nature of the work.


 

EMBRACING FLEXIBILITY

The phased nature of the project also impacted the design. Due to the appropriations approvals required for each phase, it was entirely possible that funding would not be available for future phases. As such, each phase had to be designed as a “complete and usable” facility. While the projects were designed to be “finished” at the end of each phase, once subsequent contracts were awarded and construction began, the finished state of each phase was sometimes no longer viable. For example, room layouts and building exteriors were often changed when tie-ins were made. Some details and tie-ins then had to be re-designed and coordinated depending on the state of construction on each phase.

Another design challenge arose because of differences in steel design. Each phase required the structural steel design to be compliant with Anti-Terrorism/Force Protection and progressive collapse requirements. Phase one was built with a structural steel system of moment connections. In phases two and three, the design-bid-build contract documents required the use of a system called SidePlate, which accomplished the same objectives using different connection details. While both systems meet the project requirements independently, additional structural work was required to ensure that the phase two and phase three structure would tie-into the already completed phase one structure.

Designing the “complete and usable” phases required a novel approach to organizing the facility. Instead of focusing on designing three separate buildings, the team envisioned the entire project within a “plug-and-play” design concept. The inspiration behind this was that once the first clinical space was completed in phase one (along with the central energy plant), additional facilities could be “plugged in” to the plant as they were completed. The team designed the utility tunnel as a “spine” from the central energy plant to the phase one building. The utilities installed in this tunnel included taps for future expansion, allowing for tacking on future modules.

“Complete and usable” also meant that in order to be finalized the building would need a finished exterior. From a design perspective, this meant providing options. For example, exterior walls where two phases would intersect were designed with two options: one that left the wall open and unfinished (ready for the next connection by a following phase); and another with a finish, such as an exterior insulation and finish systems wall, in the event future phases were delayed or cancelled. Finishes were chosen based on minimizing potential cost and ease of removal and replacement.

 

ENSURING PROJECT SUCCESS

While many of the circumstances on the Wilford Hall project are unique, there are key takeaways any design or construction team should consider when building a military construction project.

Communication and collaboration can never be understated. Never assume everyone knows what you are doing or that you have all the information. Military construction projects often involve numerous stakeholders. It is crucial to implement processes early on and meet regularly to track progress. The more you work together, the more you will be able to identify and resolve potential issues before they arise.

Ultimately, the team must be ready, willing and able to adapt to changes in the design, logistics or the mission. Understanding that there will be challenges and confronting them collectively goes a long way to ensuring a successful project.

  


 

Ryan Aalsma, M.SAME, is Project Executive, Skanska USA; This email address is being protected from spambots. You need JavaScript enabled to view it..

Jack Sullivan, P.E., PMP, M.SAME, is Vice President, HDR Inc.; This email address is being protected from spambots. You need JavaScript enabled to view it..

Jeffrey Allen is Senior Project Manager, USACE Fort Worth District; This email address is being protected from spambots. You need JavaScript enabled to view it..